Phacoemulsification versus manual small-incision cataract surgery for white cataract

To compare the safety and efficacy of phacoemulsification and manual small-incision cataract surgery (SICS) to treat white cataracts in southern India.

Aravind Eye Hospital, Pondicherry, India.

Randomized prospective study.

Consecutive patients with white cataract were randomly assigned to have phacoemulsification or manual SICS by 1 of 3 surgeons experienced in both techniques. Surgical complications, operative time, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, and surgically induced astigmatism were compared.

On the first postoperative day, the UDVA was comparable in the 2 groups (P = .805) and the manual SICS group had less corneal edema (10.2%) than the phacoemulsification group (18.7%) (P = .047). At 6 weeks, the UDVA was 20/60 or better in 99 patients (87.6%) in the phacoemulsification group and 96 patients (82.0%) in the manual SICS group (P = .10) and the CDVA was 20/60 or better in 112 (99.0%) and 115 (98.2%), respectively (P = .59). The mean time was statistically significantly shorter in the manual SICS group (8.8 minutes ± 3.4 [SD]) than in the phacoemulsification group (12.2 ± 4.6 minutes) (P<.001). Posterior capsule rupture occurred in 3 eyes (2.2%) in the phacoemulsification group and 2 eyes (1.4%) in the manual SICS group (P = .681).

Both techniques achieved excellent visual outcomes with low complication rates. Because manual SICS is significantly faster, less expensive, and less technology-dependent than phacoemulsification, it may be a more appropriate technique in eyes with mature cataract in the developing world.